ART, preventing HIV spread to children and TB-HIV in-focus at ASICON-2013

Shobha Shukla - CNS
Mumbai will be host to the 6th National Conference of AIDS Society of India (ASICON 2013) from 13th to 15th December. As its theme HIV/AIDS: Scaling New Heights – From Prevention & Treatment …Towards Cure suggests, the conference will focus on vital issues in the journey of the HIV epidemic from prevention and treatment towards possible cure. 45 national and 25 international eminent speakers are expected to share their expertise on a variety of subjects during this 3 day long event, informed Dr IS Gilada, President, AIDS Society of India.
There were an estimated 2.1 million people living with HIV (PLHIV) in India in 2012, as per the UNAIDS Global Report 2013. India ranks number three in the world by way of HIV incidence, with Maharashtra, Andhra Pradesh and Karnataka being the worst HIV-affected states. Yet the affordable generic anti- retroviral therapy (ART) drugs manufactured in India make it the global saviour by meeting over 80% of the world’s ART requirements, thereby preventing deaths and ameliorating the sufferings of millions of PLHIV. Ironically, as we save millions of lives globally we are losing thousands to HIV nationally. The National AIDS Control Organisation (NACO) records that every year out of the 65,000 HIV positive mothers, 18,000 pass on the virus to their infants at birth, even though there are strategies to prevent mother to child transmission of HIV. It is heartening that NACO has now changed its outdated strategy of giving a single-dose nevirapine to HIV positive women (which also created drug resistance in HIV positive mothers and children) and decided to provide the best available ART to expecting HIV positive mothers as per option B+ recommended by the World Health Organization (WHO).

Another problem that needs to be tackled is HIV-TB co-infection. India, with approximately 1.3 million notified new cases of TB in 2012 and 44,000 HIV patients co-infected with TB, is staring at a problem of significant magnitude. Limitations of conventional diagnostic tests for detection of TB in PLHIV, and vice versa, contribute to the silent epidemic. Patients with HIV-TB co-infection also have a higher mortality. In 2010, it was estimated that 1/3rd of the dually infected died. Compounding this problem is the rise of multi drug resistant TB (MDR-TB). India has an MDR-TB incidence of 3% in new cases and 15-20% in retreatment cases. MDR-TB co-infection is a significant problem in PLHIV, with higher rates of MDR-TB in them resulting in significantly higher mortality.

TB is a curable disease and HIV is treatable. The dual epidemic can be challenged with a concerted effort from all stakeholders beginning with a high index of suspicion. Early diagnosis, treatment and prevention of TB in PLHIV (through early ART initiation) and early diagnosis and treatment of HIV in TB patients are essential for this to happen. This requires an understanding of the microbes, the disease, the co-infection, the collusion, and the role of diagnostics in preventing a catastrophe and casualty. Against the backdrop of current epidemiology, identifying the drug resistant status has become as important as detecting the presence of the disease causing agent for both these diseases. A variety of newer phenotypic tests with improved detection and a reduced turnaround time are now available. Newer and simpler molecular platforms are beginning to provide hope for individual case management as well as for control of transmission.

Keeping these objectives in mind, a day long preconference workshop on HIV & Tuberculosis: Choosing the Right Diagnostics to Challenge ‘Co-Infection, Collusion, Catastrophe and Casualty’ is also being organized as part of ASICON 2013, on 12th December by the Department of Microbiology, Seth GS Medical College and KEM Hospital Mumbai. It will have lectures delivered by experts in their respective fields followed by demonstration on conventional and recent diagnostics for TB and HIV. An understanding of the utility of recent diagnostics in better management of patients and thereby control of disease burden is expected to help clinicians and diagnostic laboratories.

The global AIDS Epidemic has completed 32 years of its devastating presence. HIV care was started in India when the Indian Health Organisation (now called People’s Health Organisation – India) established the first ever AIDS Clinic in 1986 at the state-run JJ Hospital, Mumbai. That was also the year when a patient died of full blown AIDS in 1986 at Mumbai’s Jaslok Hospital. We have come a long way since then and currently HIV care is being provided in more than 360 government and an equal number of private set-ups. Marking the completion of 27 years of HIV care in India, AIDS Society of India (ASI) has launched a series of updates and training programmes to sensitise physicians involved in HIV care. ASI’s academic initiative helps medical caregivers update their knowledge on the latest happenings in the vibrant field of HIV/AIDS.

However, the programme to be widely effective for longer duration, multi sectorial collaboration is required, especially among the policy makers and planners, care givers, pharmaceuticals and researchers. This forthcoming National conference is one such effort in this direction by bringing together around 700 delegates (including 40 from abroad) representing medical doctors, researchers, stake-holders and pharmaceutical companies on a common platform.

Shobha Shukla, Citizen News Service - CNSDecember 2013(The author is the Managing Editor of Citizen News Service - CNS. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, violence against women and girls, and MDR-TB. Email: shobha@citizen-news.org, website: www.citizen-news.org) Published in: Citizen News Service (CNS), India